(Reprinted from the CMSA April 2010 Monthly Newsletter)
Pat Stricker, RN, Med
Vice President, Clinical and Client Services
TCS Healthcare Technologies
When managing patients who are suffering from a number of co-morbidities, clinicians are often challenged with the number of clinical guidelines and treatment options that are available through public and commercial resources (e.g., from the Internet, written publications, electronic software applications, or other resources).
If a case manager is treating a chronically ill patient with three or four disease states, it is very difficult to manually patch together an effective care plan that includes a comprehensive review of the problems, a clear set of unified goals, and an integrated care strategy. As a result, many case managers will identify the primary health condition or disease state to be addressed with each patient. However, by focusing on only the primary condition, other health issues may be overlooked.
Therefore, a central challenge for clinicians today is to identify the most appropriate clinical guidelines for the populations that they serve and then be able to customize those guidelines for each patient in an efficient and clinically appropriate manner. While finding and integrating different guidelines and other clinical resources into actionable information is paramount for the effective practice of case management, it is also difficult and time-consuming.
Traditionally, clinical guidelines have a specialized focused such as those that are developed by specialty societies covering a specific health condition or branch of medicine. Other guidelines may concentrate on specific business or clinical workflows, such as length of stay (LOS) or nurse triage.
The good news is that technology now offers case managers and other caregivers new opportunities to develop higher-level care plans that incorporate a wide variety of evidence-based guidelines. Several of the leading care management software systems now do this. Information about a patient can be collected through health risk assessments, patient interviews, clinical data or other sources and then manually entered, downloaded, and/or synchronized into an integrated database. Identified risk factors in this data can automatically trigger a proposed, customized care plan. The case manager can then accept, change, or reject each suggestion or add other specific components that address individualized patient needs.
This standardized process provides up-to-date guidelines, standardization of practice, improved documentation, increased efficiency and productivity, improved reporting capabilities, and improved patient and program outcomes. Of course, clinical oversight is imperative throughout this process to make sure that the care plan is optimized and individualized for each case. In addition, some systems are better than others, so it is important to have these information technology (IT) solutions peer-reviewed and validated.
Because of the continued development of new clinical guidelines and medical breakthroughs, health IT systems will continue to assume an instrumental role in helping clinicians develop, integrate and customize care plans that are flexible, transparent and contemporary. In addition, the practice of case management is beginning to develop its own “evidence-based knowledge library” by effectively integrating disparate guidelines into coherent care plans that support chronically-ill populations. This is especially needed to help patients navigate the healthcare system and to promote better transitions of care and health outcomes.